Travel Medicine

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International Sanitary Regulation (1951) International Health Regulation (1969)

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IHR pada awalnya untuk mengontrol enam penyakit infeksi utama yaitu: cholera, plague,
yellow fever, smallpox, relapsing fever, dan typhus. Tetapi saat ini yg utama hanya cholera,
plague dan yellow fever.

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existing, new and reemerging diseases, including emergencies caused by noninfectious disease
agents

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Travelers Health : responsibilities of clinician, traveller, travel industry

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Responsibilities of Clinicians : melindungi dirinya dari potential health risks, ttg vaksinasi
dan pemberian obat, travels medical history, assessment of the epidemiology of endemic
diseases, health risks at the destination, dan behavioral risks (pre-travel consultation) posttravel medical care

6.

Questions for Persons Preparing to Travel

When are you traveling, and how long will you be at each location? Where are you traveling? In
what countries will you be traveling? Where within the country or countries will you be traveling?
Are these destinations urban areas or rural areas? What are the conditions of your lodging (such as
hotel with air conditioning, screened cabin, or open-air tents)? What activities will you be doing
while traveling (such as hiking, backpacking, scuba diving, sightseeing, etc.)? Have you traveled
internationally in the past? Where did you go? When did you travel? How old are you? What
vaccinations have you had previously?

When did you have these vaccinations?

How many doses did you have of a particular vaccine? (for example, some vaccines,
such as the hepatitis A and B vaccines or the measles/mumps/rubellaMMR
vaccine, require multiple doses for long-term protection)

Did you have any allergies or reactions to any previous vaccines?

Do you have any other allergies (for example, medications, foods, or environmental)?

In particular, do you have an allergy to eggs, latex, yeast, mercury, or thimerosal?

(eggs Yellow fever and influenza vaccine: thimerosal Japanese encephalitis

vaccines)

What is your medical history and current health status (for example, past illnesses and
surgeries, chronic health problems, or other underlying medical conditions)?

What medications are you currently taking or have you taken in the past 3 months?

Are you immune deficient?

If you are a female,

Are you pregnant now?

Are you trying to become pregnant, or will you try to become pregnant in the next 3
months?


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Are you breast-feeding?

Responsibilities of Travelers : 4-6 minggu sebelum perjalanannya. Bila perlu konsultasi

dengan expertnya atau membuka web site CDC Travelers Health untuk melihat advis yang
lebih up-date.
Responsibilities of Travel Industry : travel health risks dan vaccinations. harus punya jaringan
dengan klinik-klinik/RS yang berguna untuk peningkatan pengetahuan mereka dan untuk
memberikan sesi penyuluhan bagi para petugas industry
Travel Notices : 1. In the news : lowest level of notice 2. Outbreak news : Provides
information about a disease outbreak in a limited geographic area or setting. 3. Travel health
precautions : larger geographic area so travelers can take measures to reduce the risk of
infection, also provides guidance to travelers about what to do if they become ill while in the
area CDC recommended limiting exposure to a defined setting, such as poultry farms or
health-care settings. 4. Travel Health Warning : Recommends against nonessential travel to
an area because a disease of public health concern is expanding outside the areas or
populations that were initially affected to reduce risk of spreading the disease. Eg : SARS
Protection against mosquitoes, tick, flea : repellents containing DEET, avoidance outdoor
activities during twilight period(dusk and dawn), wearing long sleeve clothes, bed nets treated
with permethrin, aerosol insecticides.
Risk from food and water : Higher risk : E.coli, shigellosis or bacillary dysentery,
cryptoporodiosis, giardiasis, norvovirus, hepatitis A
Lower risk : Typhoid, helmith
disease, rotavirus, cholera, protozoa Prevention : Boiling, Chemical disinfection , water
filter
Southeast Asia : dengue fever, diarrheal disease, respiratory infection.
Vector-borne infection : Dengue Fever, Malaria, Japanese Encephalitis, chikungunya, scrub
typhus, relapsing fever, filariasis
Food and water borne : Hepatitis A, diarrhea, polio, campylobacter, Cholera, Hepatitis E,
Cysticercosis(Indonesia)
Airborne and person-person : TB, Measles, SARS, Influenza
Sexually transmitted and blood-borne : HIV, Hepatitis B , chronic Hepatitis C, chancroid
Zoonotic Infection : Rabies, H5N1, anthrax
Soil and water associations infection : Schistosomiasis(S.japonicum), Leptospirosis, larva
migrant
JE : vaccine 3 doses of each 1ml(>3years old) 0.5ml(1-2 age) administered subcutaneously on
day 0,7, 30
Rabies : pre-exposure : Human Diploid Cell Rabies Virus (HDCV) Purified Chick Embryo
Cell vaccine (PCEC) 1ml IM 3 doses 0 7 21 or 28
Rabies : post-exposure : rabies Immunoglobulin(RIG)
Not immunized : RIG 20IU/kg +
HDCV or PCEC 1ml 5doses 0 3 7 21 or 28 IM
Immunized : HDCV or PCEC 2doses day
0 3 IM